Desvignes F, Pouly J L, Janny L, Canis M, Sanfilippo S, Kanold J, Lebouedec G, Brugnon F
Pôle de gynécologie-obstétrique-reproduction humaine, médecine de la reproduction, CHU de Clermont-Ferrand, CHU d'Estaing, 1, place Lucie-Aubrac, 63003 Clermont-Ferrand cedex 1, France.
Pôle de gynécologie-obstétrique-reproduction humaine, médecine de la reproduction, CHU de Clermont-Ferrand, CHU d'Estaing, 1, place Lucie-Aubrac, 63003 Clermont-Ferrand cedex 1, France.
Gynecol Obstet Fertil. 2014 May;42(5):334-42. doi: 10.1016/j.gyobfe.2014.01.010. Epub 2014 Apr 29.
Ovarian Tissue Cryopreservation (OTC) is a very promising approach of fertility preservation for women and young patients who have to follow gonadotoxic treatments (chemotherapy, radiotherapy…). The aim of this study was to analyse the indications and the outcomes of the patients who had OTC in our center during the last 17 years.
The study is retrospective. Forty-six patients, who underwent OTC in the Laboratory of Reproductive Biology of the University Hospital of Clermont-Ferrand, between January 1997 and December 2009, were included.
The average age on the day of ovarian tissue harvesting was 19.5 years. Fifty-two percent of the patients were minor. In order of decreasing frequency, the diseases for which OTC has been proposed were hematologic, ovarian tumors, sarcoma ou PNET and breast neoplasia. In 93.5 %, the harvesting of ovarian cortex was performed by laparoscopy. After OTC, 82.6 % of the patients were treated by chemotherapy. A bone marrow transplant was performed for 48 % of the study patients. At the time of data collection, 57 % of the patients who had evaluation of their ovarian function presented premature ovarian failure. Eight patients had one or more pregnancies after treatment. It was a natural pregnancy for five of them. The three others were obtained by medically assisted procreation (in vitro fertilization and oocyte donation).
We report a long-term follow-up of patients treated in our center for OTC. The originality of our study is to evaluate all aspects of OTC from the decision to propose the patients an OTC to their outcomes several years after the ovarian tissue harvesting. It is therefore a multidisciplinary approach both oncology, gynecological and pediatric whereas OTC is often considered restrictively in the literature. Finally, it seems to be essential to establish a specific medical care for these patients. This monitoring will allow an adequate assessment of pubertal development and ovarian function, management of estrogen deficiency and secondary infertility, supporting patients in their desire for motherhood.
卵巢组织冷冻保存（OTC）对于那些必须接受性腺毒性治疗（化疗、放疗等）的女性和年轻患者而言，是一种非常有前景的生育力保存方法。本研究的目的是分析过去17年中在我们中心接受OTC治疗的患者的适应证和治疗结果。
本研究为回顾性研究。纳入了1997年1月至2009年12月期间在克莱蒙费朗大学医院生殖生物学实验室接受OTC治疗的46例患者。
卵巢组织采集当天的平均年龄为19.5岁。52%的患者为未成年人。按频率递减顺序，提出OTC治疗的疾病依次为血液系统疾病、卵巢肿瘤、肉瘤或原始神经外胚层肿瘤以及乳腺肿瘤。93.5%的患者通过腹腔镜进行卵巢皮质采集。OTC治疗后，82.6%的患者接受了化疗。48%的研究患者进行了骨髓移植。在数据收集时，评估卵巢功能的患者中有57%出现了卵巢早衰。8例患者在治疗后有一次或多次妊娠。其中5例为自然妊娠。另外3例通过辅助生殖技术（体外受精和卵母细胞捐赠）获得。
我们报告了在我们中心接受OTC治疗患者的长期随访情况。我们研究的独特之处在于评估OTC的各个方面，从决定为患者提供OTC治疗到卵巢组织采集数年之后的治疗结果。因此，这是一种肿瘤学、妇科和儿科的多学科方法，而在文献中OTC常常被狭义地看待。最后，为这些患者建立特定的医疗护理似乎至关重要。这种监测将有助于充分评估青春期发育和卵巢功能、管理雌激素缺乏和继发性不孕，支持患者实现生育愿望。
